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Viral infections Flashcards

1
Q

HSV-1 Herpes Labialis

A

Primary 6 months - 6 years old then latent in trigeminal ganglion

does best in mucosa and non intact skin (pharynx, eyes, lips)

yellow vesicles with red borders that burst into ulcers, crust on oropharynx, eyes, lips, genitals

secondary exposure will reactivate, often symptomatic

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2
Q

transmission of HSV1 herpes labialis

A

shed in saliva, close contact
wear glasses, mask
prevent prodromal symptoms with antivirals

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3
Q

HSV-1 Herpetic Whitlow

A

less common
occurs on fingers
red border, yellow vesicle

no dental work till resolved, self inoculation risk

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4
Q

Acute Herpetic Gingivostomatitis (primary herpes)

A

most common HSV infection, rapid onset

6 months-5 years old, sick
multiple vesicles rupture to ulcers on palate, lips, tongue, attached ging, vermillion border

gingival enlargement

avoid dental tx for 14 days

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5
Q

HSV-2 genital herpes

A

genital/oral
vesicles or ulcers

big increase in incidence
shed while asymptomatic

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6
Q

HSV 2 transmission

A

shed in saliva/genital secretions

risk of transmission to baby during birth (aseptic meningitis) but does not cross placenta

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7
Q

HSV-3 varicella zoster chicken pox

A

primary virus in dorsal spinal ganglion
VZV is primary symptomatic infection
total body rash, itchy
perioral and oral lesions

followed by latency, if it recurs= herpes zoster/shingles

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8
Q

HSV-3 transmission VZV

A

transmit thru air droplets and direct contact with lesions

risk if pregnant (defects, abortion), vaccinate MMR, avoid dental tx

tx: antiviral meds, non aspirin antipyretics to avoid Reyes Syndrome

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9
Q

HSV-3 Herpes Zoster complications

A

post herpetic neuralgia, Ramsey Hunt syndrome, blindness, tooth exfoliation, necrosis of mand

important to take antivirals within 72 hrs, treat oral lesions with topical, avoid contact with preg/unvaccinated

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10
Q

HSV-3 Shingles

A

recurrent unilateral vesicles, pustules, ulcers that crust

can affect 3 branches of trigeminal nerve, eyes, palate, ramus to midline on one side, trunk

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11
Q

HSV-4 EBV infectious mono

A

virus replicates in oropharynx
remains in host for life

oral hairy leukoplakia: white mucosal plaque on lateral tongue that does not rub off
commonly seen in AIDS, organ transplant, immunosuppressive aids

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12
Q

HSV-4 EBV transmission

A

shed in saliva, assoc with HIV

carcinomas: nasopharyngeal, Burkitt’s lymphoma, Hodgkin’s lymphoma, all CNS lymphomas in in AIDS, risk factor for non-Hodgkin’s

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13
Q

HSV5 Cytomegalovirus

A

persistent ulcers

50% of population infected by 40 years old
reactivated by preg, aids, blood transfusions

90% asymptomatic
symptomatic: chorioretinitis in AIDS <50

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14
Q

HSV-5 Cytomegalovirus transmission

A

shed in saliva, body fluids, crosses placenta affecting fetus (mental affects, deaf, heart defects)

assoc with AIDS <50 CD4

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15
Q

HSV-6 Roseola

A

3 months-3 years
sudden maculopapular rash, blanches
seizures with high fever

replicate in salivary glands

may also have otitis, GI, resp distress

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16
Q

HSV-7 Exanthem Subitum

A

fever with or without rash

usually older children

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17
Q

HSV-8 Kaposi’s sarcoma

A

painless purple red macules

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18
Q

HSV-9 Kaposi’s risks/tx

A

malignancy assoc wtih HIV/Aids

tx: chemo, excise, radiation, antiviral

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19
Q

Viruses

A

intracellular that infect cells to replicate
transient or long term infections, malignancy potential
reactivation with recurrent infections
all cause primary infection as child, remain latent
weakened defenses
shed in saliva or genital secretions

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20
Q

HSV-1 vs HSV-2

A

both are identical clinically, different locations
associated with non infectious processes (erythema multiforme)
affects epithelial cells

tx: primary= antivirals, restrict contact
recurrent= acyclovir in prodromal phase

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21
Q

Recurrent Herpes Simplex (secondary herpes)

A

most common at vermillion border
15-45% prevalence

prodromal: burning, itching, tingling
then multiple, red small red papules that form clusters of vesicles which rupture, crust heal with no scar

postpone dental

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22
Q

HSV-3 Herpes Zoster/Shingles

A

virus stored in dorsal ganglia or trigeminal ganglion
fever, malaise, pain, lymphadenopathy

3 phases
Prodrome: intense pain, inflammatory rxn
Acute: prodromal rash, vesicles, ulcers crust
Chronic: 15%, persistent pain

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23
Q

Cocksackie virus A16 (hand, foot, mouth)

A

symptomatic infections with rashes

intraoral: red sores on B mucosa, tongue, palate that turn into vesicles then blisters
extraoral: red macules then rash that blisters on palms, hands, soles, feet

2 types: herpangina and acute lymphononodular pharyngitis

24
Q

Cocksackie virus A16 transmission

A

fecal/oral and throat secretions

common in crowded areas with poor hygiene

postpone dental tx for all forms of virus due to contagious

25
Herpangina
A16 common in children and summertime diffuse gray and red vesicles rupture then ulcers on posterior mouth, soft palate, pharyngeal tonsils/pillars lasts 3-4 days when fever breaks
26
Acute Lymphononodular Pharyngitis
vesicles or small nodules in pharyngeal area and tonsillar pillars rare, children mostly caused by A10
27
Paramyxovirus: Rubeola (hard measles)
prodromal: white koplik spots on oral mucosa then maculopapular rash on face fever ends, rash fades can cause pitted enamel, blind, death, pneumonia, encephalitis
28
Paramyxovirus: hard measles rubeola tx
vaccine MMR | avoid dental tx contagious
29
Togovirus: Rubella (german measles)
prodromal: Forscheimer's sign in 20% dark red papules on soft/hard palate rash for 2 weeks on face, neck, trunk crosses placenta barrier= birth defects (1st tri) usually in spring
30
Togovirus: german measles, rubella transmission
resp drop, nasopharyngeal secretions reschedule if risk contact with preg person
31
Mumps: paramyxovirus
diffuse disease of exocrine glands (salivary gland best site) salivary gland swelling (20%) usually parotid and bilateral, may involve sublingual gland Pain on chewing, ear swelling complications: meningitis, deaf, arthritis etc.
32
Mumps: paramyxovirus tx
vaccine MMR postpone dental tx till safe
33
Human Papilloma Virus
over 140 viruses 24 assoc with head and neck 1/3 of pop, shed in saliva HIV+ more likely to have HPV family: retroviridae genus: lentivirus
34
HPV oral squamous papilloma
caused by HPV 2,6,11,57 white-pink, painless, pedunculated, sessile, multiple exophytic nodules, cauliflower like on lips, mucosa, soft palate or tongue need to remove to avoid transmission
35
HPV verruca vulgaris/common wart
caused by HPV 2,4,6,40 starts as painless papule with papillary projections/pebbly surface pedunculated, sessile, enlarges stays for months to years, disappears spontaneously 2/3 of the time found on vermillion border, lip mucosa, ant tongue
36
HPV verruca vulgaris transmission
virus enters thru break in skin, remove as it's contagious, avoid self inoculation
37
HPV condyloma acuminatum/venereal wart
30 types of HPV 6,11 low risk 16, 18= 95% of cervical cancer EO: may be invisible multiple, flat, pink, exophytic w/ sessile bases, cauliflower like IO: painless papular pink exophytic mass with rough appearance, often clustered. enlarge to nodules found on: labial mucosa, soft palate, labial/lingual frenum, oropharynx
38
HPV Condyloma Acuminatum/venereal wart transmission
HPV 16, 18, 31, 45 transmission is high risk of malignancy tx: excision, antiviral, vaccine before sexually active child abuse concern
39
HPV: Multifocal Epithelial Hyperplasia (Heck disease)
HPV 13 and 32 generalized pink translucency, cauliflower like with multiple discrete papules soft on palpation less papular then other HPV found on lips, tongue, B mucosa
40
HPV: Multifocal Epithelial Hyperplasia transmission
virus enter thru break/trauma in mucosa genetic and environmental predisposition (school, day care) regresses or time or remove it
41
HPV: Sinonasal Papillomas
nodules in nostrils HPV 6, 11 HPV 16, 18 are malignancy risk assoc with sq cell carcinoma
42
periodontitis/gingivitis
ANUG, ANP, linear gingival erythema tx: schedule regular perio maintenance therapy
43
HIV/AIDS
xerostomia and enlarged salivary glands recurrent aphthous ulcers: never vesicular at first or clustered or prodromal ranulas (swelling, sub lingual sal glands that don't drain) schedule regular perio therapy
44
Risk Factors for HPV
male, smoking, cannabis, 16 or more lifetime partners
45
Role of DH
hx of smoking 85% sex 69% comfortable to share lab testing for HPV
46
Vaccine for HPV
prevents 100% of 16 and 18 and 99% for 6 and 11 Gardasil covers all 4 types, M/W recommended 9-26 years old 70% of Cdns infected with HPV Dose: 15-26 years: 3 doses 2mo then 6 mon 9-14 years: 2 doses 6mo apart
47
5 types of HPV
``` squamous papilloma verruca valgaris condyloma acuminatum multifocal epi hyperplasia sinonasal papillomas ```
48
CD4 receptors + enzymes
destroy T helper cells and NK cells, invade, reduce production of Ab 3 enzymes: reverse transcriptase, protease, integrase capable of antigenic variation
49
Progression of HIV
Health: 800-1200 T cells Stage I: >400 cells (acute retroviral syndrome) stage II: 200-400 cells (clinical latency) stage III: <200 cells (AIDS)
50
200-500 count
thrush, OHL, shingles, TB
51
<200
HSV, Candida esophagitis, PCP, Kaposi's, HPV
52
<100
histoplasmosis, toxoplasmosis, cryptococcosis
53
<50
aspergilli, mycobacterium, avium complex (MAC), Cytomegalovirus (CMV)
54
Other Oral Manifestations
Candidiasis: pseudomembranous, erythematous, hyperplastic (smoking). yellow white curd like deposits that bleed OHL: bilateral white plaque on tongue border, EBV TB: painful nonhealing ulcers on mucosa HSV: recurrent herpetic stomatitis; vesicles become ulcers, kaposi's; purple red macules Histoplasmosis: ulcers with indurated borders Cryptococcosis(yeast): nonspecific ulcers Cytomegalovirus HSV5: irregular ulcers covered with pseudomembranous, persistent Tonsillitis
55
IO manifestations significant to HIV pts
Aspergillosis: large necrotic ulcers with black coat Toxoplasmosis: lymphadenopathy Syphilis: chancre, mucus patches, gumma Odynophagia: pain on swallow Lymphadenopathy GI reflex disease Non hodgkin lymphoma: rapid painful masses often ulcerating on ging or palate
56
Crimean- Congo Hemorrhagic Fever
tick borne virus headache, fever, back pain, vomit red throat, petechia on palate, red eyes, jaundice, mood changes large areas of bruising, uncontrolled bleeding, nose bleeds 50% fatal, no vaccine yet prevent with repellent, gloves, long sleeves bioterrorism

Oral Path (3 decks)

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